• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.131-157
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• 2015

NHIS claimed for damages to doctors that by doing the treatment breaching medical insurance criteria caused by doctors, NHIS paid for medicine cost to pharmacy; as a result, the doctors caused the tort to NHIS. Following consecutive rulings afterwards, NHIS also argued that the medicine cost violating medical law or medical treatment expense paid to medical organizations are both the tort in civil law. NHIS claimed for all the damages, and the Supreme Court confirmed this judgment. However, within our national health insurance system, the subject of insurance payment is NHIS and the subject of medical treatment expense are also NHIS since the treatment expense is also insurance payment by asking the treatment to medical organizations. Further, national health insurance law is not made to control the violation of medical treatment cases; therefore, the breach of medical law cannot be covered by illegality of tort in civil law regarding NHIS. If that is the case, in the case that if the patients are treated according to treatment criteria via the doctors delegated the doctors' permission by Health and Welfare minister, NHIS acquired the benefits to remove the duty to give treatment payment to doctors in civil law; thus, even though the doctors have breached the medical law, NHIS does not have any damages. The fact that supreme court confirmed the ruling that the treatment is the tort in civil law towards NHIS is the judgment not counting the benefits of insurance payment as the subject but only considering the fact that NHIS paid to the doctors and this ruling have gone against the principle under civil code section 750. If the doctors have breached the medical law, the case should be sanctioned by medical law not national health insurance law, and the ruling of supreme court is assumed that they have confused both with the principle of national health insurance law and civil law.

• 방재와보험
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• s.109
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• pp.70-71
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• 2005

현대인에게 숙면은 다음 날 일상생활의 활력을 주는 필수요소이다. 코골이는 숙면을 방해해 일상생활의 능률이 떨어뜨릴 뿐 아니라 같이 잠자리에 드는 가족도 덩달아 숙면을 취할 수 없게 만들고 심지어는 코고는 소리에 의해 소음성 난청이 유발되기도 한다.

• 한국IT서비스학회:학술대회논문집
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• 2010.05a
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• pp.9-16
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• 2010

대한민국의 의료보험은 크게 국가에서 운영하는 국민건강보험과 국민이 선택적으로 가입하는 민간의료보험으로 나눌 수 있다. 국민건강보험과는 달리 민간의료보험 청구와 정산은 각 보험사별로 이루어지고, 또한 그 절차도 각자 독자적인 방법과 순서를 따라 진행되어 보험가입자의 불편 해소 및 업무의 효과적 추진을 위한 방안이 모색되어왔다. 이에 민간의료보헙협의체(KPPO)에서는 2009년부터 HNIP의 바로One 서비스를 통하여 병원, 보험회사, 보험가입자를 연계하는 보험 청구 및 지원서비스를 개발하여 운영하고 있다. 의료기관-보험사-보험가입자를 연계하는 전략적 협력 융합 서비스 구축을 토대로, 기존에 서로 연계되지 않고 오프라인으로 진행되던 보험금 청구 프로세스를 효과적이고 체계적인 관계로 발전시켰다. 그리고, 다자간의 새로운 정보 유통망의 구축 및 융합 서비스를 통하여 업무의 표준화, 다자간의 관련 업무 프로세스의 효율화를 도모하였다. 이러한 융합서비스를 통하여 규모의 경제, 고객의 편의 및 만족 증대, 기업의 사회적 책임 달성, 신뢰의 구축 등 융합서비스 구축의 다양한 시너지효과를 기대한다.

• Journal of the Korea Convergence Society
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• v.9 no.2
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• pp.125-136
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• 2018

The purpose of the study is to investigate dental health insurance coverage the awareness and dental health insurance coverage extension to scaling in service consumers. There were significant differences according to education level, age on the appropriateness of the age of yearly scaling benefit, and to married, regions, self-oral health of the frequency of yearly scaling benefit, who their teeth brushed frequence a day on the appropriateness of the fee of yearly scaling benefit. It implies that should be added to the coverage list national health insurance every age group after increasing periodontal disease. It is to be more extension as to age, frequency and fee health insurance coverage of scaling, the effort to improve dental health insurance coverage policy must be continue for oral health in the future.

• The Southeast Asian review
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• v.28 no.1
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• pp.173-218
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• 2018

This study focuses on the healthcare sector in Vietnam which is promoting universal health insurance for the achievement of Universal Health Coverage (UHC) under Sustainable Development Goals (SDGs). The purpose of this study is to examine the characteristics of the reform process of the health care system and the law on health insurance through the historical and cultural contexts and its implications from the perspective of development. Based on the three dimensions of UHC - extension of protection for population, provision of various medical services, and financial protection, the current status of the Vietnam healthcare sector is summarized respectively as follows. First, according to the revised Health Insurance law which came into effect in 2015, the mandatory health insurance premiums are calculated based on household units. Second, there is a medical network that can provide preventive and healthcare services centered on primary health care facilities, for example commune health stations (trạm y $t{\hat{e}}$ $X{\tilde{a}}$). Third, out-of-pocket expenditure is still a large proportion although public spending has increased and private spending has decreased since the enforcement of the health insurance law and various schemes. Vietnam is currently striving towards a universal health care system. The development of institutions and systems should be designed in a way that is appropriate for the members of the society rather than efficiency. This article findings shed light on the role of social values, family culture, and informal institutions.

• Journal of the Korean hospital association
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• v.31 no.2 s.276
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• pp.11-21
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• 2002

건강보험 재정위기는 장기적으로 누적되어 온 적자 요인에다 2000년 관리체계의 통합과 동시에 시행된 의약분업과 수가인상으로 일시에 재정수요가 집중되면서 발생하게 되었다는데 대한 분석에는 별다른 이견이 없다. 다만, 각각의 제도 변화가 어느 정도 영향을 미쳤는지에 대한 견해 차이를 갖는 정도이다.

• 방재와보험
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• s.90
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• pp.64-65
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• 2001

날이 더워지면서 수험생들이 가장 나기 어려운 계절, 승부의 계절, 여름이 오고 있다. 심리적인 압박감도 증가하고 학기초의 결연한 의지도 점점 나약해져 가기 시작한다. 수험생에게는 여름을 어떻게 나느냐가 앞으로 남은 인생을 좌우할 만큼 중요한 시점이기도 하다. 이번 호에서는 집에서 할 수 있는 간단한 수험생 건강법을 알아보도록 하자.

• 월간산업보건
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• s.260
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• pp.69-81
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• 2009

$\bullet$ 목적 본 연구는 한국의 생산직 근로자와 사무직 근로자의 직업성 손상 및 질환의 차이를 비교하고 산재보고 축소(underreporting)의 규모를 추정하고자 수행되었다. $\bullet$ 방법 한국의 경인지역에서 구축된 근로자 건강진단 수진자 코호트와 1999-2001년 사이에 재직 중이었던 근로자의 건강보험 청구자료를 이용하였다. 근로자의 직무내용과 건강진단의 종류(특수건강진단 및 일반건강진단)로 사무직과 생산직 근로자로 구분하였으며, 이들 사이의 근골격계질환과 손상 및 중독에 해당하는 건강보험 이용률의 차이를 신고되지 않은 산재로 추정하였다. 이를 바탕으로 도수율, 산재발생률 및 재해율을 계산하였다. $\bullet$ 결과 생산직 근로자는 사무직 근로자보다 100 인년 당 3.47건 더 높은 건강보험이용률을 보였다. 이를 토대로 추정한 한국의 도수율은 12.57-18.1, 재해율은 2.74-3.29, 산재발생률은 3.62-5.44이었다. $\bullet$ 결론 한국 제조업의 산재발생률은 공식적인 통계보다 2-3배 더 높을 것으로 추정되지만, 연구의 제한점을 고려하여 이해할 필요가 있다.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1024-1037
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• 2020

The resource-based relative value scale (RBRVS) compares the value of a medical practice to the consumption of resources, which consist of the work of the physician, practice expenses, and professional liability insurance. At the time of the 2nd revision of RBRVS, the fee for radiological examinations had been reduced due to the high preservation rate. In RBRVS, practice expenses account for most of the compensation of radiological examinations, and physicians' work is relatively undervalued. A new healthcare policy (Moon Jae-In care) consists of the expansion of the National Health Insurance (NHI) coverage, reduction of patient charges for the vulnerable class, and support for catastrophic medical expenses. However, Moon Jae-In care is expected to negatively affect the NHI in Korea financially. The expansion of the insurance coverage for ultrasonography and MRI examinations is a significant part of the Moon Jae-In care, and radiological societies should establish fair compensations for physicians' work within the field of radiology while implementing the Moon Jae-In care.

• Journal of Digital Convergence
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• v.20 no.5
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• pp.643-651
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• 2022

This study was conducted to examine the oral health, dental treatment and insurance awareness of the community during the COVID-19 period from September 1 to October 29, 2021 for patients who visited a local dental clinic in Gangwon-do. For analysis, SPSS Statistics 24.0 program was used. As a result of the analysis, it was found that oral health status, interest in oral health, and awareness of health insurance expansion affect dental treatment during the COVID-19 period. In addition, those who did not receive oral health education, those with a high school diploma or lower, and those with poor oral health showed positive results for dental treatment during the COVID-19. In conclusion, it is necessary to expand publicity on oral health education, and to list the cost of infection control in health insurance and separate compensation materials. In future research, I think that it is necessary to conduct research through a variety of subjects and study the expansion of insurance in detail.